MEDICARE: TRACEY FARMER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	1079447	KY

General Provider Information

NPI Number	:	1518049535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY FARMER

Provider Business Mailing Address
First Line	:	PO BOX 614
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42241-0614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 HAMMOND PLZ
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-4971
Country	:	US
Telephone Number	:	270-886-2205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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Directions to “ TRACEY FARMER ” Practice Location

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